Tian Yan, Holzman Claudia, Slaughter-Acey Jaime, Margerison-Zilko Claire, Luo Zhehui, Todem David
Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, 909 Fee Road Room B601, East Lansing, Michigan, 48824, USA.
College of Nursing and Health Professions, Drexel University, 245 N 15th St, Mailstop 501, Philadelphia, PA, 19102, USA.
Matern Child Health J. 2018 Nov;22(11):1647-1658. doi: 10.1007/s10995-018-2562-6.
Objective Growing evidence suggests that maternal socioeconomic mobility (SM) is associated with pregnancy outcomes. Our study investigated the association between maternal SM from childhood to adulthood and the risk of preterm delivery (PTD), and examined heterogeneity of associations by race/ethnicity. Methods In this study, 3019 pregnant women enrolled from 5 Michigan communities at 16-27 weeks' gestation (1998-2004) provided their parents' socioeconomic position (SEP) indicators (education, occupation, receipt of public assistance) and their own and child's father's SEP indicators (education, occupation, Medicaid status, and household income) at the time of enrollment. Latent class analysis was used to identify latent classes of childhood SEP indicators, adulthood SEP indicators, and SM from childhood to adulthood, respectively. A model-based approach to latent class analysis with distal outcome assessed relations between latent class and PTD, overall and within race/ethnicity groups. Results Three latent classes (low, middle, high) were identified for childhood SEP indicators and adulthood SEP indicators, respectively; while four latent classes (static low, upward, downward, and static high) best described SM. Women with upward SM had decreased odds of PTD (Odds ratio = 0.60, 95% confidence interval: 0.42, 0.87), compared to those with static low SEP. This SM advantage was true for all women and most pronounced in white/others women. Conclusions Maternal experiences of upward SM may be important considerations when assessing PTD risk. Our results support the argument that policies and programs aimed at improving women's SEP could lower PTD rates.
目的 越来越多的证据表明，母亲的社会经济流动性（SM）与妊娠结局相关。我们的研究调查了母亲从童年到成年的SM与早产（PTD）风险之间的关联，并按种族/民族检查了关联的异质性。方法 在本研究中，1998 - 2004年从密歇根州5个社区招募的3019名妊娠16 - 27周的孕妇提供了她们父母的社会经济地位（SEP）指标（教育程度、职业、接受公共援助情况）以及她们自己和孩子父亲在入组时的SEP指标（教育程度、职业、医疗补助状态和家庭收入）。分别使用潜在类别分析来确定童年SEP指标、成年SEP指标以及从童年到成年的SM的潜在类别。一种基于模型的潜在类别分析方法，通过远端结局评估潜在类别与PTD之间的总体关系以及种族/民族组内的关系。结果 童年SEP指标和成年SEP指标分别确定了三个潜在类别（低、中、高）；而四个潜在类别（静态低、上升、下降和静态高）最能描述SM。与静态低SEP的女性相比，SM上升的女性发生PTD的几率降低（优势比 = 0.60，95%置信区间：0.42，0.87）。这种SM优势对所有女性都成立，在白人/其他女性中最为明显。结论 在评估PTD风险时，母亲SM上升的经历可能是重要的考虑因素。我们的结果支持这样的观点，即旨在改善女性SEP的政策和项目可以降低PTD发生率。
